Background Hypertension is a major course of diastolic dysfunction and heart failure with preserved ejection fraction. Cardiovascular morbidity is increased in South Asian (SA) and African-Caribbean (AC) ethnic groups. Scarce data are available on the contribution of ethnicity to diastolic dysfunction in hypertensive patients. We aimed to assess this it in an epidemiological screening study, Ethnic – Echocardiographic Heart of England Screening E-ECHOES.
Methods A total of 1546 hypertensive participants in E-ECHOES with left ventricular ejection fraction > = 55% were included: 830 of SA origin and 716 of AC origin. People with history of ischaemic heart disease, cardiac valves pathology, peripheral artery disease, cancer, chronic obstructive pulmonary disease, and atrial fibrillation were excluded.
Results AC subjects were older than SA patients (65+/-11 vs. 62+/-10 years, p < 0.001), had higher body mass index (30+/-6 vs. 29+/-5 kg/m2, p < 0.001) and mean systolic blood pressure (150+/-19 vs. 147+/-20 mmHg, p = 0.002). There was no statistical differencez in gender, ejection fraction, diastolic blood pressure and history of smoking (p = NS). SA patients had a higher prevalence of diabetes (47% vs. 35%, p < 0.001).
Diastolic dysfunction was present in 73% of SA and 72% of AC patients. Increased left ventricular filling pressure (E/’e > = 13) was present in 14% of SA and 11% of AC patients. On stepwise forward multivariable logistic regression analysis, SA ethnicity was independently predictive of diastolic dysfunction and increased left ventricular filling pressure (Table 1). SA origin was independently predictive of increase left ventricular filling pressure [Odds Ratio (OR) 0.48, 95% confidence interval (CI)] 0.34–0.69] for AC origin, along with age (OR 1.06, 95% CI 1.04–1.07 per 1 year), female gender (OR 2.48, 95% CI 1.73–3.56), higher left ventricular mass index (OR 1.01, 95% CI 1.00–1.01 per 1 g/m2) and higher systolic blood pressure (OR 1.02, 95% CI 1.01–1.03) per 1 mmHg), p < 0.001 for all.
Conclusion SA ethnicity is independently associated with diastolic dysfunction and increased left ventricular filling pressure in subjects with arterial hypertension. Better understanding of mechanisms underlying this observation may help identify new therapeutic targets in hypertension.
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